Elastic compression garments help promote venous and lymphatic return by gently compressing the limb with gradient pressure thereby limiting the amount of swelling and maintaining the reduction in swelling achieved following other treatments.
External compression reduces ultrafiltration from the vasculature, enhances the musculoskeletal pump, increases the re-absorption of fluid into the venous and lymphatic system, reduces the local volume in the veins, and helps maintain the limb shape.
Compression garments may be in the form of a stocking and cover an ankle, the lower leg, a knee, a thigh or an entire leg to the waist. Compression garments are also sleeves and or gloves, used for elbows, hands, the lower arm, an entire arm and the like.
Medical compression garments typically are grouped by compression classes measured in millimeters of mercury (mmHg). These are standardized as:
Class I: 20–30 mmHg
Class II: 3040 mmHg
Class III: 40–50 mmHg
Class IV: 50–60 mmHg
In a stocking, these numbers are the compression at the ankle with a gradually decreasing compression gradient to the top of the garment. Many ready-made stockings have a higher stretch fabric over the upper thigh called a mantissa. Garments with the same fabric throughout will give lower compression over a larger diameter body part. Arm sleeves are generally Class I or II, and gloves are typically Class I. Lower extremity garments are generally Class II or III. Additional compression for the leg can be gained by using a higher compression class of garment or by layering a knee-high stocking under or over a longer stocking.
Compression stockings and sleeves are typically made of elastic fabrics. The fibers used are generally latex rubber, synthetic rubbers, nylon, polyester, cotton, or a blend. A stocking or sleeve may be lined with cotton or silk, making the garment more comfortable. Fabrics can be thick or thin, depending on the fibers used and the amount of compression provided. In general, heavier fabrics are used for higher compressions.
There are several styles of garment construction: circular knit, flat knit, and cut and sew. Circular knit fabrics are seamless, but have a tendency to roll down at the top, especially if the area it covers is very fleshy. This creates a tourniquet effect, obstructing flow of fluid from the limb. In a flat knit garment, a flat piece of fabric is knitted to the patient's measurements, and seamed up the back. A cut and sew garment is made of several pieces seamed together. Each of these garments roll less at the top, but rolling is still a problem.
To be effective and comfortable, the garment has to stay in place. A garment that rolls creates a tourniquet-like effect that can cause blood clots. Rolling typically causes pressure that creates an indent in the skin that is painful.
Attempts have been made to create a garment that stays up. Silicone bands or body adhesive used inside the top edge of the garment and are known in the art, but are not adequate. In the case of a stocking, a garter belt, suspenders, or an extension of the garment to the waist are available. Extensions over the shoulder that attach to a bra strap or a diagonal strap across the chest are available for sleeves. Various tapes and even rubber bands have been tried.
None of these devices is acceptable for most patients who are required to wear such garments because they are uncomfortable and ineffective in keeping the top of the garment in place. Adhesives may work initially, but are typically do not last. Tape typically does not adhere to the garment and is difficult to remove from skin, especially skin covered with hair. Existing garters and suspenders may show under clothing, are difficult to put on and are generally uncomfortable. All of these devices may adhere to other clothing.
The condition of the patient's skin is also a consideration. A patient may have wounds or fragile or sensitive skin. The addition of bands or body adhesive is not a universally acceptable means of correcting the problem in that latex and synthetic rubbers may induce an allergic reaction, causing itching, which may result in torn skin from scratching.
A need exists for an independent device for use with an elastic compression garment that is adjustable and can be used with a variety of types of compress bandages and garments, such as all types of stockings and sleeves. A device that is easily adjusted in response to swelling is desired. A need exists for a device that maintains the top of the garment effectively and comfortably without adhering to other clothing.